Ginecomastia: aspectos generales y etiológicos

Palabras clave: ginecomastia, hipogonadismo, testosterona, andrógenos, estrógenos.

Resumen

La ginecomastia es el crecimiento mamario benigno en el varón. Etiológicamente se clasifica en fisiológica y patológica. La ginecomastia fisiológica se presenta frecuentemente en ciertos periodos de la vida, como la época neonatal, puberal y senil. La patológica se asocia a múltiples factores, incluyendo los hormonales, los de origen tumoral, y al uso de ciertos medicamentos, entre otros; sin embargo, en muchos pacientes no se consigue identificar nunca la causa. La historia clínica y el examen físico son los pilares fundamentales que permiten orientar hacia la etiología, con el apoyo de pruebas de laboratorio e imagenología que permitan descartar una enfermedad clínica subyacente. En los casos moderados o severos, la cirugía es el tratamiento de elección. El objetivo del presente manuscrito es discutir algunos puntos de interés acerca de los aspectos más importantes relacionados con la ginecomastia, incluyendo la fisiopatología, la clínica y el diagnóstico, además de presentar las principales causas asociadas a esta condición. Por último, se describen los tipos de tratamiento disponibles para estos pacientes.

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Biografía del autor/a

Oscar Alejandro Bonilla-Sepúlveda, Clínica Las Américas, UniRemington

Médico, Especialista en Mastología, MSc en Epidemiología y Salud Pública. Grupo de Investigación en Cáncer (IDC), Clínica Las Américas. Profesor, UniRemington. Medellín, Colombia.
https://orcid.org/0000-0001-9485-7483

Referencias bibliográficas

Vandeven HA, Pensler JM. Gynecomastia. Treasure Island (FL): StatPearls Publishing; 2020. Acceso 7 de octubre de 2020. Disponi- ble en https://www.ncbi.nlm.nih.gov/books/NBK430812/.

Narula HS, Carlson HE. Gynecomastia. Endocrinol Metab Clin North Am 2007;36:497-519. https://doi.org/10.1016/j.ecl.2007.03.013.

Costanzo PR, Pacenza NA, Aszpis SM, Suárez SM, Pragier UM, Usher JGS, et al. Clinical and etiological aspects of gynecomastia in adult males: A multicenter study. Biomed Res Int 2018;2018:8364824. https://doi.org/10.1155/2018/8364824.

Costanzo P, Suarez S, Aszpis S, Usher JG, Pra- gier U, Cayoja M, et al. Ginecomastia: aspec- tos clínicos y etiológicos. Estudio retrospectivo y multicéntrico. Rev Argent Endocrinol Metab 2015;52:22-28.

Barrantes-Rodríguez K. Ginecomastia: manifes- taciones, etiología, abordaje diagnóstico y tratamiento. Med Leg Costa Rica 2016;33:205-210.

Nuttall FQ. Gynecomastia as a physical finding in normal men. J Clin Endocrinol Metab 1979;48:338-340. https://doi.org/10.1210/jcem-48-2-338.

Carlson HE. Gynecomastia. N Engl J Med 1980;303:795-799. https://doi.org/10.1056/nejm198010023031405.

Nydick M, Bustos J, Dale JH, Jr., Rawson RW. Gynecomastia in adolescent boys. Jama 1961;178:449-454. https://doi.org/10.1001/jama.1961.03040440001001.

Kanakis GA, Nordkap L, Bang AK, Calogero AE, Bártfai G, Corona G, et al. EAA clinical practice guidelines-gynecomastia evaluation and management. Andrology 2019;7:778-793. https://doi.org/10.1111/andr.12636.

Braunstein GD. Clinical practice. Gynecomastia. N Engl J Med 2007;357:1229-1237. https://doi.org/10.1056/NEJMcp070677.

Lorek M, Tobolska-Lorek D, Kalina-Faska B, Januszek-Trzciakowska A, Gawlik A. Clinical and biochemical phenotype of adolescent males with gynecomastia. J Clin Res Pediatr Endocrinol 2019;11:388-394. https://doi.org/10.4274/jcrpe.galenos.2019.2019.0027.

Sansone A, Romanelli F, Sansone M, Lenzi A, Di Luigi L. Gynecomastia and hormones. Endocrine 2017;55:37-44. https://doi.org/10.1007/s12020-016-0975-9.

Narula HS, Carlson HE. Gynaecomastia--Pathophysiology, diagnosis and treatment. Nat Rev Endocrinol 2014;10:684-698. https://doi.org/10.1038/nrendo.2014.139.

Karagiannis A, Harsoulis F. Gonadal dysfunction in systemic diseases. Eur J Endocrinol 2005;152:501-513. https://doi.org/10.1530/eje.1.01886.

Fricke A, Lehner GM, Stark GB, Penna V. Gynecomastia: histological appearance in different age groups. J Plast Surg Hand Surg 2018;52:166-171. https://doi.org/10.1080/2000656x.2017.1372291.

Calderón O W, Cabello P R, Israel V G, Bassa S J, Kauak K L, Olguín M F, et al. Ginecomastia y pseudoginecomastia: Tratamiento. Rev Chil Cir 2009;61:131-135.

Einav-Bachar R, Phillip M, Aurbach-Klipper Y, Lazar L. Prepubertal gynaecomastia: aetiology, course and outcome. Clin Endocrinol (Oxf) 2004;61:55-60. https://doi.org/10.1111/j.1365-2265.2004.02059.x.

Mieritz MG, Rakêt LL, Hagen CP, Nielsen JE, Talman LM, Petersen JH, et al. A longitudinal study of growth, sex steroids, and IGF-1 in boys with physiological gynecomastia. J Clin Endocrinol Metab 2015;100:3752-3759. https://doi.org/10.1210/jc.2015-2836.

Morcos RN, Kizy T. Gynecomastia: when is treatment indicated? J Fam Pract 2012;61:719- 725.

Krysiak R, Okopień B. [Gynecomastia]. Pol Merkur Lekarski 2012;32:187-193.

Haynes BA, Mookadam F. Male gynecomastia. Mayo Clin Proc 2009;84:672-672. https://doi.org/10.1016/S0025-6196(11)60515-6.

Cakan N, Kamat D. Gynecomastia: evaluation and treatment recommendations for primary care providers. Clin Pediatr (Phila) 2007;46:487-490. https://doi.org/10.1177/0009922806294800.

Braunstein GD. Environmental gynecomastiatia. Endocr Pract 2008;14:409-411. https://doi.org/10.4158/ep.14.4.409.

Rosenfeld VR. Andropausia o deficiencia androgénica del adulto mayor. Rev Med Clin Cond 2009;20:161-165.

Montes JM. Andropausia o HIT – Diagnóstico y tratamiento del déficit de testosterona. Medicina 2010;5:53-65.

Zirkin BR, Tenover JL. Aging and declining testosterone: past, present, and hopes for the future. J Andrology 2012;33:1111-1118. https://doi.org/10.2164/jandrol.112.017160.

Thompson DF, Carter JR. Drug-induced gynecomastia. Pharmacotherapy 1993;13:37-45. https://doi.org/10.1002/j.1875-9114.1993.tb02688.x.

Ismail AA, Barth JH. Endocrinology of gynaecomastia. Ann Clin Biochem 2001;38:596-607. https://doi.org/10.1258/0004563011900993.

Mathur R, Braunstein GD. Gynecomastia: pathomechanisms and treatment strategies. Horm Res 1997;48:95-102. https://doi.org/10.1159/000185497.

Mieritz MG, Christiansen P, Jensen MB, Joen- sen UN, Nordkap L, Olesen IA, et al. Gynaecomastia in 786 adult men: clinical and biochemical findings. Eur J Endocrinol 2017;176:555-566. https://doi.org/10.1530/eje-16-0643.

Ford HC, Cooke RR, Keightley EA, Feek CM. Serum levels of free and bound testosterone in hyperthyroidism. Clin Endocrinol (Oxf) 1992;36:187-192. https://doi.org/10.1111/j.1365-2265.1992.tb00956.x.

Barrios-Ospino Y, Díaz N, Meertens L, Naddaf G, Solano L, Fernández M, et al. [Relation bet- ween leptin serun with weight and body fat dis- tribution in postmenopausal women]. Nutr Hosp 2010;25:80-84.

Braunstein GD. Aromatase and gynecomastia. Endocr Relat Cancer 1999;6:315-324. https://doi.org/10.1677/erc.0.0060315.

Stanworth R, Jones T. Testosterone in obesity, metabolic syndrome and type 2 diabetes. Front Horm Res 2009;37:74-90. https://doi.org/10.1159/000176046.

Barros AC, Sampaio MdC. Gynecomastia: physiopathology, evaluation and treatment. Sao Paulo Med J 2012;130:187-197.

Hershkovitz E, Leiberman E. Gynecomastia: A review. Endocrinologist 2002;12:321-332. https://doi.org/10.1097/00019616-200207000-00010.

Carlson HE. Approach to the patient with gynecomastia. J Clin Endocrinol Metab 2011;96:15- 21. https://doi.org/10.1210/jcem.96.9.zeg15a.

Magro G, Gangemi P, Villari L, Greco P. Deci- duoid-like stromal cells in a diabetic patient with bilateral gynecomastia: a potential diagnostic pitfall. Virchows Archiv 2004;445:659-660.

Pearlman G, Carlson HE. Gynecomastia: An update. Endocrinologist 2006;16:109-115. https://doi.org/10.1097/01.ten.0000205637.20746.10.

García-Benayas T, Blanco F, Martín- Carbonero L, Valencia E, Barrios A, González-Lahoz J, et al. Gynecomastia in HIV-Infected patients receiving anti- retroviral therapy. AIDS Res Hum Retro- viruses 2003;19:739-741. https://doi.org/10.1089/088922203769232539.

Krause W. Drug-inducing gynaecomastia--a critical review. Andrologia 2012;44 Suppl 1:621-626. https://doi.org/10.1111/j.1439-0272.2011.01240.x.

Holzbeierlein JM. Managing complications of androgen deprivation therapy for prostate cancer. Urol Clin North Am 2006;33:181-190. https://doi.org/10.1016/j.ucl.2005.12.008.

Manolis AA, Manolis TA, Melita H, Manolis AS. Spotlight on spironolactone oral suspension for the treatment of heart failure: Focus on patient selection and perspectives. Vasc Health Risk Manag 2019;15:571-579. https://doi.org/10.2147/VHRM.S210150.

Skeldon SC, Carleton B, Brophy JM, Sod- hi M, Etminan M. Statin medications and the risk of gynecomastia. Clin Endocrinol 2018;89:470-473. https://doi.org/10.1111/cen.13794.

Dickson G. Gynecomastia. Am Fam Physician 2012;85:716-722.

Basaria S. Androgen abuse in athletes: detection and consequences. J Clin Endocrinol Metab 2010;95:1533-1543. https://doi.org/10.1210/jc.2009-1579.

Rouach H, Fataccioli V, Gentil M, French SW, Morimoto M, Nordmann R. Effect of chronic ethanol feeding on lipid peroxidation and protein oxidation in relation to liver pathology. Hepatology 1997;25:351-355. https://doi.org/10.1002/hep.510250216.

Sauer MA, Rifka SM, Hawks RL, Cutler GB, Jr., Loriaux DL. Marijuana: interaction with the estrogen receptor. J Pharmacol Exp Ther 1983;224:404-407.

Dursun F, Su Dur ŞM, Şahin C, Kırmızıbekmez H, Karabulut MH, Yörük A. A rare cause of prepubertal gynecomastia: Sertoli cell tumor. Case Rep Pediatr 2015;2015:439239. https://doi.org/10.1155/2015/439239.

Chentli F, Bekkaye I, Azzoug S. Feminizing adrenocortical tumors: Literature review. Indian J Endocrinol Metab 2015;19:332-339. https://doi.org/10.4103/2230-8210.152764.

Brinton LA. Breast cancer risk among patients with Klinefelter syndrome. Acta Paediatr 2011;100:814-818. https://doi.org/10.1111/j.1651-2227.2010.02131.x.

Ersöz H, Onde ME, Terekeci H, Kurtoglu S, Tor H. Causes of gynecomastia in young adult ma- les and factors associated with idiopathic gynaecomastia. Int J Androl 2002;25:312-316. https://doi.org/10.1046/j.1365-2605.2002.00374.x.

Sarıca Ö, Kahraman AN, Öztürk E, Teke M. Efficiency of imaging modalities in male breast disease: Can ultrasound give additional information for assessment of gynecomastia evolution? Eur J Breast Health 2018;14:29-34. https://doi.org/10.5152/ejbh.2017.3416.

Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg 1973;51:48-52. https://doi.org/10.1097/00006534-197301000-00009.

Nordt CA, DiVasta AD. Gynecomas- tia in adolescents. Curr Opin Pediatr 2008;20:375-382. https://doi.org/10.1097/MOP.0b013e328306a07c.

Nuttall FQ. Gynecomastia. Mayo Clin Proc 2010;85:961-962. https://doi.org/10.4065/mcp.2010.0093.

Martínez-Tlahuel JL, Arce C, Lara FU. Cáncer de mama en el hombre. Cancerología 2006;1:201-210.

Hines SL, Tan WW, Yasrebi M, DePeri ER, Perez EA. The role of mammography in male patients with breast symptoms. Mayo Clin Proc 2007;82:297-300. https://doi.org/10.4065/82.3.297.

Mayo Clinic. Enlarged breasts in men (gynecomastia). Minnesota, USA: Mayo Foundation for Medical Education and Research; 2019. Acceso 08 de julio de 2020. Disponible en https://www.mayoclinic.org/diseases-conditions/gynecomastia/diagnosis-treatment/drc-20351799.

Cuhaci N, Polat SB, Evranos B, Ersoy R, Cakir B. Gynecomastia: Clinical evaluation and management. Indian J Endocrinol Metab 2014;18:150-158. https://doi.org/10.4103/2230-8210.129104.

Mannu GS, Sudul M, Bettencourt-Silva JH, Tsoti SM, Cunnick G, Ahmed SF. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Breast J 2018;24:1043- 1045. https://doi.org/10.1111/tbj.13080.

Ting AC, Chow LW, Leung YF. Comparison of tamoxifen with danazol in the management of idiopathic gynecomastia. Am Surg 2000;66:38-40.

Lapid O, van Wingerden JJ, Perlemuter L. Tamoxifen therapy for the management of pubertal gynecomastia: a systematic review. J Pediatr Endocrinol Metab 2013;26:803-807. https://doi.org/10.1515/jpem-2013-0052.

Gikas P, Mokbel K. Management of gynaecomastia: an update. Int J Clin Pract 2007;61:1209-1215. https://doi.org/10.1111/j.1742-1241.2006.01095.x.

Plourde PV, Reiter EO, Jou HC, Desrochers PE, Rubin SD, Bercu BB, et al. Safety and efficacy of anastrozole for the treatment of pubertal gynecomastia: a randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab 2004;89:4428-4433. https://doi.org/10.1210/jc.2004-0082.

Boccardo F, Rubagotti A, Battaglia M, Di Ton- no P, Selvaggi FP, Conti G, et al. Evaluation of tamoxifen and anastrozole in the prevention of gynecomastia and breast pain induced by bicalutamide monotherapy of prostate cancer. J Clin Oncol 2005;23:808-815. https://doi.org/10.1200/jco.2005.12.013.

Ferraro GA, De Francesco F, Romano T, Gran- done A, D'Andrea F, Miraglia Del Giudice E, et al. Clinical and surgical management of unilateral prepubertal gynecomastia. Int J Surg Case Rep 2014;5:1158-1161. https://doi.org/10.1016/j.ijscr.2014.11.040.

Cómo citar
1.
Oscar Alejandro Bonilla-Sepúlveda. Ginecomastia: aspectos generales y etiológicos. Med. Lab. [Internet]. 4 de septiembre de 2020 [citado 17 de octubre de 2021];25(1):393-08. Disponible en: https://medicinaylaboratorio.com/index.php/myl/article/view/353
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2020-09-04
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